No abstract available.
Kidney Transplantation*

Long term use of steroid induces multiple side effects and morbidity. However, SW has been reported to be associated with increased incidence of acute and chronic rejection, and subsequently reduced graft outcome. MMF inhibits the proliferation and functions of lymphocytes, decreases the incidence of acute rejection in organ transplants, and therefore may decrease the graft rejection associated with SW. We tried to withdraw steroid from 21 renal transplants treated with prednisolone and cyclosporine, who had clinically significant steroid induced side effects. Reasons for SW were diabetes in 15 patients (pre-transplant DM 4 and post-transplant 11), moon face 4 and avascular necrosis of femur 2. Prednisolone was tapered at a rate of 2.5mg every 2 weeks and was discontinued. MMF, 1.0-2.0g/day, was initiated at the beginning of SW. The time interval between transplantation and SW was 26+/-5 (1.5-67) months. Mean age was 48(28-61). Two patients developed MMF-induced GI side effects, and were returned to previous immuno- suppressants. In 1 patient, serum creatinine increased during SW, and steroid was re-administered with the restoration of renal function. In 18(86%) of 21 patients, therefore, steroid was successfully with-drawn. At the follow up of 17+/-1(13-24) months after SW, 1 patient with drug incompliance developed chronic rejection. The rest showed stable renal function. Steroid can be safely withdrawn from renal transplants by simultaneous administration of MMF. The long-term safety, however, needs to be evaluated by prolonged follow up studies.
Creatinine ; Cyclosporine ; Femur ; Follow-Up Studies ; Graft Rejection ; Humans ; Incidence ; Kidney Transplantation ; Lymphocytes ; Necrosis ; Prednisolone ; Transplants

An intraosseous epidermal cyst is a rare benign cystic lesion. It is thought to result from congenital factors or trauma and can lead to bone destruction because the cyst develops at the soft tissue around the bone. Radiological findings of intraosseous epidermal cysts are a well-defined radiolucent lesion, with cortical expansion. It is important to differentiate an intraosseous epidermal cyst with other disease developed at distal phalanx because its clinical and radiological findings are similar. We report two rare cases of intraosseous epidermal cysts that developed at the distal phalanx.
Epidermal Cyst*

INTRODUCTION: To report the result of the thigh perforator free flap for the reconstruction of the soft tissue defect of the lower extremities and usefulness of this flap. MATERIALS AND METHODS: We have performed 23 cases of thigh perforator free flap to reconstruct the soft tissue defect of the lower extremities between February 2004 and July 2005. The anterior aspect of the legs were 9 cases, the ankle joints were 4 cases, the dorsal aspect of the feet were 6 cases, the sole of the feet were 4 cases as recipient sites. The anterolateral thighs were 13 cases, the anteromedial thighs were 10 cases as donor sites. The size of the flap ranged from 4 x 5 cm to 12 x 18 cm. The mean flap area was 73.2 cm2. The length of the pedicle ranged from 5 cm to 15 cm. Every patient except children was operated under the spinal anesthesia. RESULTS: 21 flaps (91.3%) survived, 2 flaps (8.7%) failed. In the 21 flaps that had survived, there were partial necrosis in 4 cases, which healed without any additional operation. In the 13 anterolateral thigh perforator flaps, 9 cases survived totally, 3 cases had the partial necrosis, 1 case failed. In the 10 anteromedial thigh perforator flaps, 8 cases survived totally, 1 case had the partial necrosis, 1 case failed. CONCLUSION: The authors had a good result with the thigh perforator free flap and believe that this flap is a good option for the reconstruction of the soft tissue defect of the lower extremities, because this flap has a thin thickness and it is easy to dissect the vessels. Moreover the patients can be operated with supine position.
Anesthesia, Spinal ; Ankle Joint ; Child ; Foot ; Free Tissue Flaps* ; Humans ; Leg ; Lower Extremity* ; Necrosis ; Perforator Flap ; Supine Position ; Thigh* ; Tissue Donors

To investigate the risk factors and clinical characteristics of postrenal transplant diabetes mellitus (PTDM), we reviewed the records of 177 renal allograft recipients in Maryknoll Hospiatal whose allografts had functioned longer than 6 months. Nineteen patients (10.7%) developed PTDM at 5.0+/-7.8 (1-52) months; 9 (47%) of these within 1 month. PTDM patients were older than nondiabetic renal transplants (42+/-2 vs 37+/-1 years, P<0.05). Body mass index tended to be higher in PTDM (23.5+/-1.0 vs 21.8+/-0.3kg/m2, P=0.09). Number of acute rejections (0.6+/-0.2 vs 0.5+/-0.1) and serum creatinine at 1 year after transplantation (1.2+/-0.8 vs 1.3+/-0.3mg/dL) were not different. Fasting (103.6+/-10.4 vs 84.4+/-1.6mg/dL, P<0.05) and postprandial (189.2+/-24.8 vs 118.6+/-2.3 mg/dL, P<0.01) blood sugars, measured before transplantation, were higher in PTDM. CsA blood level at 1 month posttransplantation was higher in PTDM (350+/-34 vs 279+/-8ng/mL, P<0.05). Fasting serum insulin was significantly higher (28.2+/-12.2 vs 7.3+/-2.0 microunit/dL, P<0.05) and serum C-peptide tended to be higher in PTDM patients compared with euglycemic renal recipients (6.3+/-1.6 vs 3.8+/-0.9ng/dL, P=0.08). All the PTDM patients were treated by either insulin or oral agent; 15 of 19 required no treatment after 4.7+/-6.9 months. In conclusion, prevalence of PTDM was 10.7%. PTDM patients were older. Body mass index was tended to be higher. Fasting and postprandial blood sugars, measured before transplantation, were higher in PTDM. Faslting serum insulin was higher and C-peptide tended to be higher in diabetics. These results suggested that increased insulin resistance plays a major role in the pathogenesis of PTDM.
Allografts ; Blood Glucose ; Body Mass Index ; C-Peptide ; Creatinine ; Cyclosporine ; Diabetes Mellitus* ; Fasting ; Humans ; Insulin ; Insulin Resistance ; Prevalence ; Risk Factors*

BACKGROUND: A pleural effusion is not a disease entity but a clincial sign of systemic or pleural disease. Although the diagnosis of pleural effusion can often be done by toracentesis and pleural needle biopsy the yeild of positive diagnosis is low.
Biopsy, Needle ; Diagnosis ; Pleural Diseases ; Pleural Effusion* ; Thoracoscopy*

BACKGROUND/AIMS: Bloating is common bothersome symptoms and most studies conducted in the Western countries found that bloating was frequently associated with lower gastrointestinal (GI) symptoms but many patients complaint bloating as upper GI symptoms in the clinical setting. This study was conducted to assess the prevalence of bloating, and to identify symptom grouping and finally document the impact of bloating in the diagnosis of functional GI disorders. METHODS: Participants in a comprehensive health-screening cohort were enrolled. They were asked about demographic, medical, and social history and upper and lower GI symptoms by using a validated questionnaire. Factor analysis with principal component analysis method with varimax rotation was used. RESULTS: Among the total of 1050 subjects (mean age, 44.6 ± 10.2 years; females, 46.4%), significant bloating symptoms were found in 282 (26.9%); the prevalence of functional bloating was 6.9%. Factor analysis revealed a 5-component structure with upper GI symptoms, constipation, diarrhea-predominant irritable bowel syndrome (IBS), constipation-predominant IBS, and fecal incontinence. Abdominal bloating loaded on both the upper GI symptoms (0.51 of loadings) and constipation (0.40). On logistic regression analysis, bloating was more predictable for IBS (OR, 7.5; P < 0.001) than functional dyspepsia (FD; OR, 3.7; P = 0.002). Bloating was more frequently combined with IBS according to their severity, but this association was not detected in patients with FD. CONCLUSIONS: Abdominal bloating is common symptom in about a quarter of patients and appears as upper as well as lower GI symptoms. However, abdominal bloating is more predictable for IBS, especially constipation-predominant IBS, than FD.
Cohort Studies ; Constipation ; Diagnosis ; Dyspepsia ; Epidemiology ; Fecal Incontinence ; Female ; Gastrointestinal Diseases* ; Humans ; Irritable Bowel Syndrome ; Logistic Models ; Methods ; Prevalence ; Principal Component Analysis

Budd-Chiari syndrome (BCS) is a rare disease caused by the obstruction of the hepatic venous outflow or the inferior vena cava above the hepatic vein. It has been attributed to various etiologic factors. Including intrinsic vascular thrombosis, hepatic tumor invasion/compression, or associated with an idiopathic obstructing membrane. However, in most cases no definitive etiologic factors have been identified. Recently, we experienced a case of 21-year-old man who had Budd-Chiari syndrome associated with diaphragmatic hernia. Venous flow returned to normal on reintroduction of the liver into the abdominal cavity and closure of the defect in the diaphragm. To our knowledge, this is the rare report in our country. Here, we report this case with review of literatures.
Abdominal Cavity ; Budd-Chiari Syndrome* ; Diaphragm ; Hepatic Veins ; Hernia ; Hernia, Diaphragmatic* ; Humans ; Liver ; Membranes ; Rare Diseases ; Thrombosis ; Vena Cava, Inferior ; Young Adult

OBJECTIVE: There are few studies comparing small and large craniotomies for the initial treatment of chronic subdural hematoma (CSDH) which had non-liquefied hematoma, multilayer intrahematomal loculations, or organization/calcification on computed tomography and magnetic resonance imaging. These procedures were compared to determine which would produce superior postoperative results. METHODS: Between 2001 and 2009, 317 consecutive patients were surgically treated for CSDH at our institution. Of these, 16 patients underwent a small craniotomy with partial membranectomy and 42 patients underwent a large craniotomy with extended membranectomy as the initial treatment. A retrospective review was performed to compare the postoperative outcomes of these two techniques, focusing on improvement of neurological status, complications, reoperation rate, and days of post-operative hospitalization. RESULTS: The mean ages were 69.4+/-12.1 and 55.6+/-9.3 years in the small and large craniotomy groups, respectively. The recurrence of hematomas requiring reoperation occurred in 50% and 10% of the small and large craniotomy patients, respectively (p<0.001). There were no significant differences in postoperative neurological status, complications, or days of hospital stay between these two groups. CONCLUSION: Among the cases of CSDH initially requiring craniotomy, the large craniotomy with extended membranectomy technique reduced the reoperation rate, compared to that of the small craniotomy with partial membranectomy technique.
Craniotomy ; Hematoma ; Hematoma, Subdural, Chronic ; Humans ; Length of Stay ; Magnetic Resonance Imaging ; Recurrence ; Reoperation ; Retrospective Studies

We report a rare case of cauda equina syndrome due to herniated lumbar disc at L4-L5 with a large extruded fragment which was located primarily posterior (dorsal) to the thecal sac. A 44-year-old man has developed lumbago and sciatica one year prior to his visit, but recently motor weakness and voiding difficulty occurred. Lumbar computed tomography scan showed a mass compressing and surrounding the thecal sac at the L4-L5 level. Urgent decompressive lumbar laminectomy was performed. The lesion proved to be a massive extruded disc fragment dorsally located to the thecal sac. It was partially connected with intervertebral disc and removed carefully to prevent dural tear and neural injury. Although sciatica was almost relieved and motor was recovered usefully, voiding difficulty and dysthesia of the lower leg were remained at 6 months follow-up examination.
Adult ; Cauda Equina* ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Laminectomy ; Leg ; Low Back Pain ; Polyradiculopathy* ; Sciatica